Opioid Testing for Drivers Garners Broad Support
This story appears in the April 10 print edition of Transport Topics.
There has been widespread support of a Department of Transportation proposal, made public earlier this year when the agency decided to amend its drug-testing program regulation, to add four opioids to its routine drug testing of commercial motor vehicle drivers.
But truckers, physicians and others who last month submitted several dozen written comments on the plan, also have wondered why it took so long to address what has been known for years as a national opioid abuse epidemic — not to mention how DOT medical experts will separate truck drivers who are abusers from those who have prescriptions to responsibly take the highly addictive drugs for pain.
In a Jan. 23 notice of proposed rulemaking, DOT said it plans to add the four Schedule II opioids to its urine drug-testing panel.
The proposed revision of the drug-testing panel is intended to “harmonize” with the revised mandatory guidelines recently established by the U.S. Department of Health and Human Services for federal drug-testing programs.
“The proposed change to include hydrocodone, hydromorphone, oxycodone and oxymorphone to the federal workplace drug-testing panel is a major advance in our nation’s efforts to effectively address the misuse of opioid painkillers,” wrote Deborah Hersman, president of the National Safety Council. “Substance use disorder involving opioid painkillers is a public health crisis with the number of deaths increasing 33% since 2011. More than 22,000 people died in 2015, and more than 12.5 million people misused opioids in the past year alone.”
The National Transportation Safety Board wrote that, in general, drivers who are new users of opioids and those with escalating doses are at increased risk of crashing while driving, although those on stable, chronic doses may not be significantly impaired.
“The addition of these substances to the DOT urine drug-testing program will likely deter misuse of these substances and ensure those who do use them are doing so legitimately and will have their use of the medications medically reviewed,” NTSB wrote.
But there is another side to the coin, according to Fred Grass, a Laurel, Mont., truck driver who said he’s been responsibly using opioids for 15 years.
“I don’t want to see this turn into a witch hunt where safe, experienced drivers are removed from the seat for unfounded reasons, political or otherwise,” Grass wrote. “Something has to be done, but overregulation is my concern.”
American Trucking Associations said it “strongly supports” the rule but added: “We view the delay in adding these four opioids for all federally regulated testing panels as unacceptable.”
“Over the last decade, this concern has caused many of our members to go above and beyond the current DOT’s minimum drug-testing regulations and implement additional testing, at additional cost, to screen for opioid use,” ATA said.
One concern over the proposal is that it is not clear how long even legitimate opioid users can take the drug and not be candidates for being disqualified from getting behind the wheel, according to Theodore Shults, chairman of the American Association of Medical Review Officers.
“In the absence of any rule or guidance, the ongoing recommendation to MROs is that they should always determine a drug test accompanied by an old prescription to be a negative and raise a safety concern,” Shults wrote.
Greg Elam, a Nashville, Tenn., medical review officer, agreed with Shults.
“As a practicing MRO for the last 21 years, I have struggled with the issues of old prescriptions and how to advise clients regarding safety concerns with controlled substances,” Elam wrote. “Guidance regarding these issues will go a long way toward making the additions to the panel more tenable and defensible.”
The AFL-CIO Transportation Trades Department said it, too, was concerned that many workers rely on opioids to be able to work, and also take them responsibly.
“These determinations can be the deciding factor in individuals keeping or losing their livelihoods and should be executed with the greatest accuracy possible,” the union wrote.
“I’m a 35-year veteran driver. I’ve got 6 million miles under my belt and no accidents,” Stacy Jourdain wrote. “I’ve been using hydrocodone now for three years. It is absolutely a drug that controls my arthritis pain.”
He added, “I agree this drug problem is a problem in the country, but I use the drug for pain when I need it. It does not affect my driving one bit, but it does control my pain, allowing me to sit in the seat for hours.”
